University of Texas School of Nursing is enrolling patients in two different studies that look at Alzheimer’s disease and sleep.
Kathy Richards, research professor and senior research scientist, has been interested in the possible connection between the two for decades. She’s heading both studies at UT.
University of Texas School of Nursing research professor and senior research scientist Kathy Richards has been studying sleep apnea and Alzheimer’s disease and restless leg syndrome and nighttime agitation in people with Alzheimer’s. University of Texas
One of the things that often happens with Alzheimer’s disease is something called “sundowning.” The person with Alzheimer’s disease becomes agitated or restless at night. Often, it’s like they have their days and nights reversed.
“It’s the most common reason for admission to the nursing home,” Richards says. It becomes hard to care for them in their home, she says, because they are up at night, when their loved ones need to be sleeping, and they try to leave home.
She knows the affect sundowning can have on a family. Richards’ aunt, who had Alzheimer’s disease, escaped from the home she shared with her husband one night. She went out to the lake, started the boat and drown, Richards says.
“That’s not as uncommon as you think,” she says.
Traditionally, sundowning was either treated by trying to improve the patient’s sleep hygiene through reducing napping and increasing exercise, she says. Sometimes patients also would be given anti-psychotics or hypnotic medications to control the behaviors, but those can lead to injuries from falls or strokes or death.
One of Richards’ studies is looking at restless leg syndrome and Alzheimer’s. Could the medication used for restless leg syndrome be beneficial to someone who has sundowning? Restless leg syndrome is a painful or uncomfortable sensation in the legs that only happens in the evening and night or gets worse at those times. It makes people feel like they have to move their legs or get up and walk around.
Restless leg syndrome is worse with people who have iron deficiencies, which tend to happen as you get older. Some antidepressants make Restless leg syndrome worsens with some antidepressants, which people with Alzheimer’s are often given to control the agitation.
Richards has been wanting to study this for 20 years, but first, she had to figure out how to diagnose restless leg syndrome without a patient being able to tell her what they were feeling. The technique she developed, first on people without Alzheimer’s, and then carried through to people with Alzheimer’s, is to have a patient sit in a chair for 20 minutes and have a nurse record the number of times their legs move. What she found was that about 75 percent of people with Alzheimer’s also had restless leg syndrome.
Now the new study, called Nighttime Agitation and Restless Leg Syndrome in People with Alzheimer’s disease is studying people with Alzheimer’s who have nighttime agitation and are in nursing homes. Some get gabapentin enacarbil, a medication approved for restless leg syndrome. The others get a placebo pill.
The hope is that if that medication works on people with Alzheimer’s disease who have nighttime agitation fewer of them will need to be in a nursing home or can stay in their own home longer. To register someone for that study, email narls@utexas.edu or call 512-475-7505.
The other project is the second part of a study that looks at people with mild cognitive impairment to see if they have sleep apnea and if using a CPAP (continuous positive airway pressure) machine would help improve their memory. An earlier study on people in nursing homes with Alzheimer’s disease found that 65 percent of them had obstructive sleep apnea. “We were very surprised by that,” she says.
The hope is that this second phase of the Memories study will study about 450 people with mild cognitive impairment. They will be tested for sleep apnea. If they already have a sleep apnea diagnosis, they can be part of the study if they were given a CPAP years ago but don’t use it. In the study, four groups of people will be looked at: People with sleep apnea who use the CPAP at least four hours a night; people with sleep apnea who use the CPAP less than four hours a night; people with sleep apnea who don’t use the CPAP; and people with mild cognitive impairment who don’t have sleep apnea.
Participants will be studied for a year. To register for that study, email mmackenzie@utexas.edu or call 512-471-9462.